Choroidal Evaluation Using Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography in Vogt–koyanagi–harada Disease

Abstract

Enhanced depth imaging spectral-domain OCT highlights a loss of focal hyperreflectivity in the inner choroid of eyes with VKH, a feature that is consistently observed by independent masked observers. The presence of this feature in both acute and convalescent phases could represent permanent structural change to small choroidal vessels caused by VKH uveitis.

Optical coherence tomography imaging in uveitis

“…There was a statistically significant increase in choroidal thickness in the acute phase compared with that in the convalescent phase by 151 lm and compared with normal by 137 lm. The thickening returned to normal in the convalescent phase [109].…”

“…It is known that the retinal findings observed in VKH disease are secondary to choroidal inflammation [107,108]. Fong et al [109] used EDI SD OCT to examine the choroid of VKH patients in the acute and convalescent stages and to compare the findings with control subjects. The authors observed multiple hyperreflective dots in the inner choroid that increased in number towards the Bruch membrane in normal control eyes and speculated that these hyperreflective dots represent cross-sectional views of parallel-lying pericapillary arterioles and venules.…”

“…Choroidal thickening leading to RPE undulation on the 3D RPE map and subretinal fluid accumulation [100,[102][103][104] Troughs of choroidal/RPE undulations correspond to hypofluorescent lines on fluorescein angiography [102] Small bumps on the surface of RPE undulations corresponding to multiple pinpoint leakage sites leading to dye pooling in the subretinal space on fluorescein angiography [102] Massive inflammatory infiltration causing compression and nonperfusion of small choroidal vessels in the inner choroid leading to a reduction in hyperreflective dots corresponding to cross-sectional views of parallel-lying pericapillary arterioles and venules [109] Subfoveal choroidal thickening [109,111] Inner retina:…”

“…FA and ICGA reveal blockage of fluorescence [106] Fundus lesions with increased autofluorescence (proliferation of RPE) manifesting as pigmented patches, irregular tracks and subretinal fibrosis show thickening of RPE/BM (RPE hyperplasia) usually with an intact outer retina. FA discloses corresponding hypofluorescence (blockage) [106] Reduction in hyperreflective dots in the inner choroid due to shrinkage and dropout of small choroidal vessels caused by stromal scarring [109] Normalization of subfoveal choroidal thickness [109,111] IS/OS = inner segment/outer segment, RPE = retinal pigment epithelium, ILM = inner limiting membrane, IPL = inner plexiform layer, BM = Bruch membrane, ELM = external limiting membrane, ONL = outer nuclear layer, FAF = fundus autofluorescence, FA = fluorescein angiography, ICGA = indocyanine green angiography stage. Reduction of hyperreflective foci in the convalescent stage was interpreted as shrinkage and dropout of small choroidal vessels caused by stromal scarring.…”

Recurrent Vogt–Koyanagi–Harada disease with sensorineural hearing loss and choroidal thickening

“…The choroid appears to be primarily affected in VKH disease initially; therefore, rebound choroidal thickening seen on EDI-OCT images could be regarded as recurrent VKH disease, as in the current case, despite no clinical evidence of recurrent ocular inflammation. Furthermore, Fong et al [9] reported that EDI-OCT highlighted a loss of focal hyperreflectivity in the inner choroid of…”